The Centers for Medicare & Medicaid Services (CMS) EHR incentive program may have started out strong, but as we approach Meaningful Use Stage 3, it’s losing steam. While CMS issued a final rule on MU3 requirements in October, physicians’ organizations have called for Congress either to delay the 2017 start date for Stage 3 or to scrap the program entirely, reports Medical Economics. A big reason: the fact that only a small percentage of physicians have attested to Stage 2.
In 2011, the first year of Meaningful Use, almost 200,000 eligible providers and over 3,000 hospitals registered for either the Medicare or Medicaid versions of the program, according to the most recent summary report from CMS. But in 2014, the program’s fourth year, fewer than 73,000 eligible providers and only 108 hospitals registered.
In 2014, participation by office-based physicians dropped significantly. The number of eligible participants who attested to MU2 was 12 percent lower than in 2013, and less than a third of providers using complete EHRs met the tougher Stage 2 requirements last year, according to Modern Healthcare. Some 62 percent of providers are still stuck at Stage 1, forcing CMS to delay the MU2 compliance date.
What’s causing Meaningful Use to lose momentum? Are the increasingly rigorous requirements worth the hassle? And what’s at stake for doctors who opt out?
Complex and costly requirements
Since the inception of Meaningful Use, the government has paid out nearly $30 billion worth of incentives to the majority of hospitals and health care providers that have adopted EHRs. So why are so many dragging their feet at Stage 2?
Steven Waldren, MD, director of the AAFP’s Alliance for eHealth Innovation, tells Modern Healthcare he sees three reasons for the decreased participation in 2014. First, Stage 2 required a costly system upgrade. Second, among those who did choose the upgrade, some had difficulty getting it delivered and installed by their EHR vendors. And third, Waldren says the Stage 2 patient engagement rules were a big turnoff for many doctors who claim that the requirement that five percent of patients use their EHR to view, download, or transfer their records holds them responsible for patient behavior beyond their control.
Also dissatisfied with Meaningful Use is John Halamka, MD, MS, chief information officer of Beth Israel Deaconess Medical Center in Boston and co-chair of the national HIT Standards Committee. He tells Medical Economics that while Stage 1 provided a solid foundation by implementing the use of a basic EHR, Stage 2 had more complex requirements. “If you’re going to change the way patients and doctors interact, or if you’re going to require data-sharing from provider to provider, there needs to be a set of infrastructure and applications to support that,” he says. “A good analogy would be, ‘I’m going to ask you to drive a car, but we haven’t built roads yet.’ So it didn’t exactly work.” Moving forward to Stage 3 presents further challenges since more advanced functions require additional infrastructure that doesn’t exist yet.
Questionable benefits
Even though the government incentives can significantly impact smaller practices, particularly independent primary care doctors, there’s mounting evidence that these reimbursements may not be enough to encourage continued participation in MU. Only 5.7 percent of those providers who received a payment for the first stage have received one for the second, reports the health care IT blog, HIStalk.
In his post on The Health Care Blog, “25 Reasons It Is Time to Kill Meaningful Use,” Hayward Zwerling, MD, cites only two “pros” of the program: the financial incentives and a proven reduction in medical errors due to Computerized Physician Order Entry (CPOE) and electronic prescribing. However, he then lists 25 “cons,” many of which can be summarized as no improvement in patient care, and increasing bureaucratic tasks that may in fact impede patient care.
By opting out of MU, a doctor receiving $100,000 annually — what the average family physician receives per year from Medicare reimbursements, according to Dr. Jason Mitchell, former director of the American Academy of Family Physicians’ Center for Health IT— could lose up to $10,000 in reimbursements through 2018. For some, however, the penalty is a small price to pay to avoid requirements that they feel hinder their ability to provide quality patient care.
Even some doctors who are big proponents of EHRs are abandoning MU. For instance, Dr. S. Steve Samudrala, medical director of America’s Family Doctors, does not participate in the program even though his EHR is fully certified through Stage 2, because he feels the reporting requirements for primary care physicians would prevent him from delivering the high quality, personal care his patients have come to expect, reports HIStalk.
Dr. Samudrala and a growing number of primary care physicians are advocates of the movement toward “direct primary care” or “concierge medicine,” which cuts out the middleman — and the bureaucracy of health insurance and government programs – and offers services directly to patients for a monthly or annual fee. HIT Standards Committee co-chair Dr. Halamka has called to “Replace the meaningful use program with alternative payment models and merit-based incentive payments.”
Is there anything good about MU?
Some industry experts predict the end of Meaningful Use as early as next year. But whatever the future of the program, it has had, and continues to have, some benefits for health care. If the goal was widespread adoption of health IT – which we can all agree is here to stay — then MU can be viewed as a success, says HIStalk. Adoption of EHRs doubled between 2009 and 2013. “Even if physicians don’t meet all the requirements to receive incentives, the benefits of health IT to providers, payers, and most importantly patients cannot be denied,” states HIStalk.
Dr. Halamka agrees: “I think the federal government has done us a great service in building a foundation, leveling the playing field, giving us some basic functionality.” Now the time has come for new solutions. Time will tell how payers, providers, patients, governments, and health care IT developers will come together and work toward positive solutions for everyone.
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